MPOG Pediatric Committee Meeting
March 2, 2026
Agenda
Announcements and Updates
AKI-03-Peds Review
New Measure Discussion: Peds Anemia
New Pediatric Subcommittee Vice Chair
Congratulations
Dr. Eva Lu-Boettcher!
Dr. Eva Lu-Boettcher is a pediatric anesthesiologist at the University of
Wisconsin, where she holds the role of Associate Vice Chair for
Quality and Safety. She has served as the site Principal Investigator
and MPOG Quality Champion since 2021, leading local efforts to
leverage data for quality improvement. Her current efforts emphasize
high-value, and environmentally sustainable anesthesia care and has
served as a measure reviewer for SUS-02, SUS-03, SUS-05-Peds and
SUS-06-Peds.
The newest pediatric hospitals to join MPOG!
Welcome….
Riley Hospital for Children
Indianapolis, IN
UCSF Benioff Children’s
Oakland, CA
Membership Update: 32 Pediatric Hospitals in MPOG
2026 Pediatric
Meetings
Pediatric Committee Meetings
• March
• June
• December
MPOG Retreat at ASA
San Diego, CA
●Friday, October 16th
New Measure Released: AKI-03-Peds
Acute Kidney Injury, Peds Cardiac
•Percentage of pediatric patients who had cardiac bypass and a baseline creatinine
increase of more than 1.5 times within 7 postoperative days, or the baseline creatinine
level increased by ≥ 0.3 mg/dL within 48 hours postoperatively.
Exclusions
•ASA 6 including Organ Procurement
•Preterm neonates and Adult patients > 18y
•Cardiac cases without cardiopulmonary bypass
•Patients with more than one case in a 7-day period.
•Patients with pre-existing renal failure (stage 4 or 5)
•Cases where a baseline creatinine is not available within 60 days preoperatively
•Cases where a creatinine lab is not available within 7 postoperative days
New Measure Build Discussion
Patient Blood Management
•Process - % of cases where patient had Preoperative Anemia
•Outcome - % of cases where patient had a Delta in Preop Hgb vs. Postop Hgb of ___
•Informational - % of cases with TXA administration; % of cases with PRBC
administration intraop
Interest in specific case types?
•Major non-cardiac
•Spinal fusions
•Craniosynostosis
Patient Based Blood Management
(1) screening for, diagnosing, and appropriately treating anemia
(2) minimizing surgical, procedural, and iatrogenic blood losses
(3) managing coagulopathic bleeding to improve patient outcomes through patient-centered care.
–Goobie, Faroni 2025 Perioperative paediatric patient blood management: a narrative review
1) To optimize and improve red cell mass by identifying and treating preoperative anemia at an early stage,
thereby preventing unnecessary transfusions.
2) To minimize blood loss and maintain the hemostatic balance as effectively as possible.
3) To enhance the patient’s physiological tolerance to anemia and coagulopathy, ultimately aiming to reduce
transfusion requirements
–Acar, Gurocak. 2025 Patient blood management in pediatric patients: current strategies and future perspectives.
What Can We Learn From Guidelines/Expert Opinion
About Who Should We Be Targeting
•Diagnose and treat anemia at least 3–6 weeks before elective surgery (ideally within an
anemia clinic setting). Consider cancelling elective major surgery to optimize hemoglobin in
high- risk patients.
–Goobie, Faroni 2025 Perioperative paediatric patient blood management: a narrative review
•Therefore, especially for elective surgeries, it is recommended to perform screening for
anemia at least 3-6 weeks prior to the scheduled operation and to initiate diagnostic and
therapeutic measures tailored to the underlying etiology if anemia is detected
–Acar, Gurocak
Who is at High Risk of Blood Transfusion
During Elective Noncardiac Surgery?
I.e. These patients are at risk of receiving blood during their case
Review of MPOG data for who gets transfusion
Create a Cohort of Patients at Risk of Transfusion & in Whom We Can
Potentially Intervene
Inclusion/Exclusion*
33,028,734 cases at 78 institutions
Procedure Date: 1/1/25 - 2/1/26
Cardiac phenotype (peds)
Excluded pt who had MRI, tonsils, intubation only, block only,
endoscopy, bronchoscopy, cystoscopy, lung transplant
< 60 minutes from anesthesia start-end
77,738 cases at 71 institutions
74,289 Cases with No
PRBC Transfusion
3,446 Cases with PRBC
Transfusion
Rate of
intraoperative
Transfusion
=4.6%
*Still refining
Age group No Transfusion Transfusion % Transfused
< 1 month 2,620 259 9%
≥ 1 month to 1 yr 10,141 720 7%
≥ 1 - 6 yr 15,485 791 5%
≥ 6 - 12 yr 16,335 504 3%
≥ 12 yr 29,708 1,172 4%
Sex
Female 32,405 1,445 4%
Male 41,884 2,001 5%
ASA Class
1 13,174 124 1%
2 26,592 555 2%
3 28,411 1,551 5%
4 5,846 1,044 15%
5 263 172 40%
6 3 0 0%
Emergent Case
No 60,958 2,610 4%
Yes 13,331 836 6%
Can we realistically
intervene on anemia in
the group?
Not really elective cases?
Not listed as elective
Surgical Specialty No
Transfusion Transfusion % of Patients OR Transfusion
General 25,658 1,076 4%
Orthopedics 13,615 667 5%
Neurosurgery 8,267 648 7%
Plastics 3,843 318 8%
Other 9,777 290 3%
Transplant 351 177 34%
Trauma / Burn 701 104 13%
Urology 5,677 60 1%
Vascular 753 59 7%
Otolaryngology 4,594 34 1%
Oral / Maxillofacial 1,053 13 1%
Mean Surgery
Duration (min) 108.83 263.41
Mean Weight (KG) 37.80 30.78
Mean HB Preop 11.97 10.57
Mean Hct Preop 35.72 31.79
Not elective cases
Reasonable chance of
intervention?
94% of patients in current cohort have a preoperative hct
Hct Obtained Days
Before No Transfusion Transfusion % of patients with Hct
1-DOS 29,404 2,072 64%
2 - ≤ 48 hrs 8,352 443 14%
3 - 48 hr - 1 wk 4,810 262 8%
4 - 1 - 2 wks 2,592 131 4%
5 - 2 wks < 1 mo. 2,871 155 5%
6 - > 1 mo. 5,266 131 4%
7 - > 6 mo. 1,903 29 1%
Representative
of true hct?
Proposed Metric: TRAN-06-Peds
Rate of anemia in patients >30 days of age, undergoing elective, major
non-cardiac surgery, who have a risk of blood transfusion estimated >=5%, who
had a hct <1 month before surgery
See you in June!
(& SPA/CCAS/SPPM)
